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Common Reasons Insurance Companies Deny Workers’ Compensation Claims 

Summary:

  • Half of all workers’ compensation claims are denied.
  • Inaccurate or incomplete information is responsible for many claim denials.
  • It’s a good idea to seek medical attention and file a claim right away.
  • You can appeal a denied workers’ compensation claim, and a qualified attorney can help you win.

Recovering from an injury is never fun, and it’s even worse when you have to deal with a denied workers’ compensation claim. If your claim has been denied after a workplace injury, you’re not alone—according to the Department of Labor, more workers’ compensation claims are denied than approved.

Even if your injury should result in a valid workers’ compensation claim, you may be denied for a small mistake with your paperwork. Let’s take a look at some of the most common reasons insurance companies will deny workers’ compensation claims.

Incomplete Documentation or Reporting Errors

Accurate and timely reporting is crucial for a successful workers’ compensation claim. Delays or errors in reporting can raise suspicion and make it difficult to prove the injury occurred at work. Common mistakes include inaccurate dates, mistakes in the description of the incident, or missing witness statements.

Discrepancies in Medical Records

Medical records are the primary source of evidence about the nature of your injury, and any issues with the medical records can have a negative impact on your claim. If different medical professionals come to different conclusions about your injury, for instance, insurance companies may use that to cast doubt on your claim.

Make sure to seek medical attention as soon as possible after your injury, and keep copies of all records involved. Review any medical records before submitting them as evidence, and contact medical personnel for clarification if you come across any discrepancies.

Questions About the Legitimacy of the Injury

Proving the work-relatedness of your injury is essential to getting your claim approved, which is one of the reasons it’s so important to report the accident to your employer and seek medical attention right away. You want an incident report and a medical record of your injury from the same day.

In some cases, insurance companies will try to downplay the severity of your injury rather than dispute it outright and may request additional medical evaluations. Make sure to send them detailed documentation and supporting evidence when making your claim.

Issues with Employment Status

Different types of employment, such as independent contractor work or full-time employment, can make a difference in how your workers’ compensation claim is handled. Depending on local laws and regulations, independent contractors may not have the same protection as full-time employees.

The insurance company may further complicate your claim by attempting to dispute your employment status at the time of the accident.

Policy Coverage and Exclusions

Workers’ compensation is a type of insurance, and each policy has different coverage and exclusions that may affect your claim. Familiarize yourself with your employer’s policy and make sure you know what types of injuries are covered before making your claim.

Some common exclusions include preexisting conditions, intentional misconduct, or injuries sustained during breaks from work.

Delay in Seeking Medical Treatment or Claim Filing

Insurance companies are suspicious of delays and may use them as grounds for a denial. Promptly seeking medical attention and reporting the accident is seen as a demonstration of the severity of your injury and the honesty of your claim.

Early medical attention and timely filing of any claim submissions tend to make a much stronger claim, even if you legally have a longer range of time in which you could file.

How Can Werner, Hoffman & Greig Help Appeal Your Workers’ Compensation Claim

If your workers’ compensation claim is denied, it’s not over yet. The team of experienced attorneys at Werner, Hoffman & Greig are here to help. We are dedicated to helping you navigate the appeals process and fight for the compensation you deserve.

We can help strengthen your appeal by:

  • Reviewing your claim denial and identifying weaknesses in your original claim.
  • Gathering and organizing evidence to support your appeal.
  • Negotiating with the insurance company on your behalf.
  • Representing you in court if necessary.

Don’t give up hope. Reach out to WHG online or call us at (800) 320-HELP to get started on your appeals process.


Frequently Asked Questions

What should I do if my workers’ compensation claim is denied?

If your workers’ compensation claim is denied, contact an attorney immediately. Your legal counsel can review your case, identify reasons for the denial, and advise you on how best to proceed.

Can I appeal a denied workers’ compensation claim?

Yes, you can appeal a denied workers’ compensation claim. The exact process varies from state to state, so be sure to work with a qualified attorney who understands the local regulations.

How can I ensure my injury is properly documented for a claim?

To ensure your injury is properly documented for a future workers’ compensation claim, you want to report the injury to your employer, take pictures and other evidence of the scene, speak to witnesses, and seek medical attention right away.

What are my rights if I’m injured at a workplace as a contractor?

If you sustain a workplace injury as an independent contractor, you may still be able to file a workers’ compensation claim. The specific rules and regulations vary from state to state, so be sure to get in touch with a qualified attorney to gain a better understanding of your options.

How does the nature of my injury affect my workers’ compensation claim?

The nature of your injury affects how much compensation you’re able to claim. In general, a more severe injury with greater medical costs and impact on your life will result in a larger settlement.

No Win, No Fee Commitment

Werner, Hoffman & Greig is committed to helping you rebuild your life after a hardship. We are not just your legal team—we are your allies, your partners, and your advocates. We will do everything we can to handle your case with compassion and care, and to get you the results you need!

“And for every fight we take on, know this…we are doing everything we can to make sure we win!”

— Werner, Hoffman & Greig

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